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Endocrine Flashcards

1
Q

How does desmopressin differ from vasopressin?

A

More potent, longer action and vasoconstriction.

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2
Q

Other than hormones, what other drugs may be used in diabetes insipidus and why?

A

Thiazides (Nephrogenic/partial if concentrated urine not restored with hormones) carbemazepine (partial)

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3
Q

What should be monitored with tolvaptan treatment?

A

Sodium and fluid as rapid correction of Hyponatreamia may cause demyelination and neurological effects

Dicontinue and perform liver function tests if hepatic impairment symptoms eg anorexia, nausea, vomiting, fatigue, abdominal pain, dark urine.

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4
Q

Are corticosteroids used in septic shock?

A

Hydrocortisone, fludrocortisone. Low dose if adrenocorticol insufficiency results from it.

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5
Q

What MHRA warning exists for corticosteroids?

A

Risk of chorioretinopathy. Report blurred vision and visual disturbance

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6
Q

What are the mineralocorticoid side effects and the corticosteroid most at risk?

A

Hypertension, sodium/water retention and potassium /calcium loss
Fludrocortisone

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7
Q

What are the glucocorticoid side effects and the corticosteroids most at risk?

A

Diabetes, osteoporosis, muscle wasting, peptic ulceration, psychiatric reactions.
Betamethasone and dexamethasone

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8
Q

Does hydrocortisone have high or low mineralocorticoid effects?

A

High. Fluid retention makes unsuitable for long term

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9
Q

Does prednisone have high or low mineralocorticoid effects?

A

Low. So glucocorticoid effects established for suppression

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10
Q

A patient has been taking 30mg prednisolone for a week. Can it be abruptly withdrawn?

A

Yes as long as unlikely to relapse. >40mg no, or more than 3 weeks, multiple courses.

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11
Q

What infections are corticosteroid patients at risk of?

A

Chicken pox, measles

Septicaemia and TB may reach advanced stage before recognised

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12
Q

Prednisolone
Sertraline

What is the problem?

A

Corticosteroids can cause psychiatric reactions

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13
Q

What corticosteroid must a patient allergic to cows milk not have?

A

Methylprednisolone

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14
Q

What can cause secondary diabetes mellitus?

A

Pancreatic damage, hepatic cirrhosis, endocrine disease.

Endocrine, antiviral and antipsychotic drugs

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15
Q

How often should insulin medicated drivers check their blood glucose?

A

Every 2 hours.

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16
Q

If blood glucose is less than 4mmol/l, what should a driver do?

A

Not drive for 45 minutes following blood glucose returning to normal, eat or drink a suitable source of sugar

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17
Q

How often should hba1c be monitored?

A

3-6 monthly. 6 monthly when stable. 3 monthly in children

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18
Q

What are the symptoms of type 1 diabetes

A

Hyperglycaemia (>11mmol/l random), ketosis, rapid weight loss, bmi <25, age <50, autoimmune history

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19
Q

What is the first line insulin choice in type 1 diabetes?

A

Basal bolus. Twice daily detemir for basal.

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20
Q

When should soluble insulin be injected and how long does it last?

A

15-30 minutes before meals. Duration of 9 hours.

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21
Q

When should RA insulin be injected and how long does it last?

A

Immediately before meals. Duration 2-5 hours.

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22
Q

When should IA insulin be injected and how long does it last?

A

One or more daily injections or mixed. Duration 11-24hours

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23
Q

When should LA insulin be injected and how long does it last?

A

Once (glargime/dugludec) or twice daily. Duration up to 36 hours.

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24
Q 
Humulin
Gliclazide
Propranolol
Ramipril
What is the issue with these combinations
A

Higher risk of hypo and beta blockers mask symptoms. Ace inhibitors potentiate effect.

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25
Q

What is the only licensed drug in children for diabetes?

A

Metformin

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26
Q

Which sulfonylureas has highest risk of hypos?

A

Glibenclamide (long acting)

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27
Q

What is the recommended target hba1c for non-hypoglycaemia risk drug patients?

A

48mmol/mol. 6.5%

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28
Q

What is the recommended target hba1c when patients are on hypoglycaemia risk drug or >1 anti diabetic?

A

53mmol/mol

7%

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29
Q

When can glucagon like peptide 1 receptor agonists be given?

A

BMI over 35 and psychological problems associated. Or lower bmi but insulin unnecessary.

Only continue after 6 months if 3% weight loss and 11mmol/mol reduction

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30
Q

What classes of drug are used in diabetic neuropathy?

A

Antidepressants, opioid, antiepileptics and capsaicin

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31
Q

What should women with pre existing diabetes planning pregnancy be advised?

A

Aim below 48mmol/mol. Take folic acid 5mg

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32
Q

What drugs should be avoided with use of desmopressin?

A

Those that increase secretion of vasopressin eg tricyclic antidepressants due to increased risk of Hyponatreamia

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33
Q

What patient advice should be given with desmopressin if taking for Nocturnal enuresis?

A

Limit fluid intake to a minimum from 1 hour before dose and until 8 hours after. Avoid fluid overload including during swimming and stop taking during vomiting or diarrhoea until fluid balance normal

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34
Q

Are corticosteroids given in the morning or night?

A

Depends on the indication. If wanted for suppression of cortisol secretion then give at night, or morning if that is preferred to be avoided.

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35
Q

How should corticosteroids be given in Addisons? Which one?

A

Hydrocortisone. Large dose in morning, smaller in evening.

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36
Q

What action should be taken with corticosteroid therapy if illness, trauma or surgery occurs?

A

Temporarily reintroduced or Increased. Same in chicken pox and should be given varicella zoster immunoglobulin if exposed and had steroids within 3 months.
Avoid exposure to measles

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37
Q

What caution of corticosteroid use is linked to reactions that may occur from the treatment?

A

Psychiatric reactions or affective disorders

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38
Q

How often should growth be recorded in children taking corticosteroid?

A

Annually

39
Q

What monitoring is done with oral ketoconazole?

A

ECG, adrenal insufficiency and Hepatitoxicity incl symptoms (fatigue, anorexia, n&v for insufficiency and jaundice, abdo pain for liver)

40
Q

When do you have to report diabetes diagnosis to the DVLA?

A

When treated with insulin. May also need to if have complications.

41
Q

Can diabetes patients drink alcohol?

A

In moderation with food. As can make hypoglycemia less clear or delay it

42
Q

What symptoms may type 1 diabetic patients experience?

A

Random glucose above 11mmol/l, ketosis, rapid weight loss. Often younger than 50 years old and lower than 25 BMI, maybe with family/personal history of Autoimmune disease

43
Q

What are the target glucose levels?

A

48mmol/mol or 6.5% hba1c
Fasting on waking 5 - 7 mmol/l
Before meals 4 - 7 mmol/l
90 mins after eating 5 - 9 mmol/l

44
Q

What situations may cause an increased or decreased insulin requirement?

A

Infection, stress, trauma increase. Physical activity, illness, reduced food intake, impaired renal function and endocrine disorders decrease.

45
Q

What advice should be given on the administration of insulin?

A

Insert into abdomen or outer thighs/buttocks. Change injection site regularly and check for signs of infections, swelling, bruising and lypohypertrophy.

46
Q

What should be regularly reviewed in diabetic patients to monitor diabetic complications? What medication is available for the complications?

A

Urinary protein and Serum creatinine. Microalbuminuria if protein negative.
ACE inhibitor or ARB (but more likely to potentiate hypoglycemic effects especially in first few weeks)

47
Q

How is diabetic keto acidosis managed?

A

Replacement of fluid and electrolytes, and insulin.
Sodium chloride, potassium chloride, soluble insulin then long acting.
Blood ketone should fall 0.5mmol/l/hr and glucose 3mmol/l/hr

48
Q

What drugs can be used in pregnancy for diabetes?

A

Metformin and insulin. Glimenclamide from 11 weeks.

49
Q

A patient is taking acarbose and is experiencing gastrointestinal discomfort, what should be advised?

A

Antacids are unlikely to benefit

50
Q

What cautions exist with metformin treatment and the resulting patient advice?

A

Risk of lactic acidosis so caution in chronic stable heart failure and drugs that impair renal function. Interrupt treatment if dehydration occurs. Seek medical attention with dyspnoea muscle cramps, abdominal pain hypothermia or asthenia.

51
Q

Which anti diabetic class can cause Pancreatitis?

A

DPP4 Inhibitors. And GLP1 receptor agonists.

52
Q

What concomitant administration of antidiabetics is often cautioned or adjusted?

A

Sulfonylurea or insulin reduced. Caution alogliptin with metformin and pioglitazone or reduce doses.

53
Q

Whihh DPP4 Inhibitor has an extra serious side effect?

A

Vildagliptin has rare reports of liver dysfunction so discontinue with jaundice etc.

54
Q

What advice should be given alongside GLP1 receptor agonists?

A

Contraception
Pancreatitis symptoms
Missed doses - usually administer if there are at least 3 days until next dose.

55
Q

What advice should be given with SGLT2 inhibitors?

A

Report volume depletion including hypotension and Dizziness. Beware of keto acidosis.

56
Q

Which anti diabetic drugs need monitoring of renal function?

A

SGLT2 inhibitors

57
Q

What side effects are most common with sulfonylureas?

A

Weight gain. Hypoglycaemia

58
Q

What advice is given with pioglitazone?

A

Seek medical attention with nausea, vomiting, abdominal pain, fatigue and dark urine (liver toxicity}

59
Q

How is hypoglycaemia treated?

A

Glucose 10-20g in liquid or sugar form, repeated after 10-15 minutes if necessary. Then a snack for sustained carbs (sandwich, fruit, milk or buscuits or next meal)

60
Q

What can be used to provide 10g of glucose?

A 
2 tsp sugar
3 sugar lumps
110ml lucozade original
100ml coca cola
19ml undiluted ribena
61
Q

What are the risk factors of osteoporosis?

A

Common in postmenopausal women, men over 50 and those taking oral glucocorticoids. Low BMI, smoker, excess alcohol, lack of physical activity or vitamin D/calcium, family history, previous fractures and early menopause.

62
Q

When should bone protection be provided?

A

Women aged 70 years or over, previous fracture or taking large doses of glucocorticoids (prednisolone 7.5mg daily).

63
Q

Which men have higher fracture risk?

A

Long term androgen deprivation therapy for prostate cancer.

64
Q

When should bisphosphonate treatment be reviewed?

A

When glucocorticoid therapy stops. After 5 years (or 3 years with zolendronic) unless over 75y,history of vertebral or hip fracture or fragility fractures during treatment,or long term glucocorticoids.

65
Q

What advice should be given with bisphosphonate and denosumab therapy

A

Report thigh hip or groin pain due to atypical femoral fractures. Keep good oral hygiene, have dental check ups and report oral symptoms, ear pain, dischwrge from the ear or infection due to osteornecrosis of the jaw and auditory canal.

Additionally report hypocalcaemia with denosumab (muscle spasm, twitch, cramp, numbness and tingling) although all are contraindicated with hypocalcaemia and recommend monitoring of it.

66
Q

Explain the significance of specific administration instructions for bisphosphonates.

A

Swallow whole with full glass of water on empty ststomach at least 30 minutes before first food or drinks, especially calcium containing products. Stand or sit upright for 30 minutes.

Due to oesophageal reactions so stop taking and seek medical attention if irritation, dysphagia, pain on swallowing, retrosternal pain or heartburn occur.

67
Q

What supplements may be advised with pamidronate? When?

A

Calcium/vitamin D. Risk of hypocalcaemia with lytic bone metastases, multiple myeloma or pagets disease.

68
Q

What drugs can be used to suppress lactation and what advice do they require?

A

Dopamine receptor agonists cabergoline, Bromocriptine and quinagolide. Can cause excessive daytime sleepiness and hypotension, so effects on skilled tasks. Often analgesics and breast support preferred.

69
Q

What advice should be given with Gonadorophin releasing hormones?

A

Non hormonal, barrier methods should be used during treatment and first injection given during menstruation if barrier not used beforehand.

70
Q

When must oestrogen be combined with a progestogen?

A

Long term therapy of women with a uterus due to risk of cystic hyperplasia of endometrium and possible formation of cancer.
Needed for last 12 to 14 days of cycle

71
Q

When HRT is given for early menopause, when should it be stopped and started? Why is it used?

A

High risk of osteoporosis before age of 45 years. Until approximate natural menopause of 50 years.

72
Q

What risks are associated with HRT?

A

VTE, stroke, endometrial/breast/ovarian cancers, CHD

73
Q

How long before surgery should HRT be stopped?

A

4 - 6 weeks

74
Q

What reasons are there to stop HRT?

A

Sudden severe chest pain, breathlessness, swelling, stomach pain, neurological effects (incl headache), liver symptoms, >160/95mmhg, prolonged immobility

75
Q

What options are there for recurrent miscarriage?

A

Low dose aspirin and prophylactic LMWH under specialist supervision if antiphospholipid antibody syndrome. Progestogen have been used but not recommended.

76
Q

Are women on HRT fertile?

A

Does not provide contraception and considered fertile for 2 years after last menstrual period if under 50, and for 1 year if over 50. Can use low oestrogen combined pill if under 50 for menopause and contraception.

77
Q

How should topical estradiol preparations be used?

A

Arms, shoulders, thighs. Using right and left sides on alternate days. Not on breast or vulva. Or face. Avoid contact with another person and don’t wash for at least an hour.

78
Q

When should risk factors effect use of ethinylestradiol?

A

Caution with one risk factor and avoid if two or more.
VTE: Family history in first degree aged under 45, obesity, long term immobilisation, thromboplebitis, over 35, smoking
ARTERIAL DISEASE: family history in first degree aged under 45, diabetes, hypertension, smoking, over 35, obesity, migraine with aura

79
Q

What advice should be given with tibilone?

A

Vaginal bleeding should be investigated for endometrial cancer if continues beyond 6 mo the or after stopping. Withdraw if signs of thromboembolism or abnormal liver function.

80
Q

A patient on Noriday for contraception normally takes their pill at midday but it has been delayed until 2:30pm, does the patient need additional precautions and for how long?

A

Not needed. 2 days of extra precautions are needed if pill delayed by 3 hours or more.

81
Q

How many days does a woman have to start a progestogen only pill following childbirth without having to use extra precautions?

A

21 days.

82
Q

What does replacement androgen therapy do?

A

Cause masculinisation. Inhibit pituitary gonadotrophin and depress spermatogenesis in normal male, so useless in impotence, infertility or impaired spermatogenesis unless associated with Hypogonadism.

83
Q

Cyproterone causes reversible infertility but why is it not a contraceptive?

A

Produces abnormal sperm forms.

84
Q

Where are testosterone gels applied?

A

Shoulder, upper arm
Abdomen, inner thighs
Not genitals.

85
Q

What monitoring is done with cyproterone?

A

Blood counts, Adrenocorticol function and hepatic function (report toxicity symptoms)

86
Q

What drugs are given in the blocking replacement regime for hyperthyroidism and when is it unsuitable?

A

Carbimazole and levothyroxine. Not in pregnancy.

87
Q

When is iodine used in hyperthyroidism?

A

10 to 14 days before partial thyroidectomy. Not long term as action diminishes.

88
Q

What drugs can be used in thyrotoxic states?

A

Radioactive iodine. Propranolol (beta blockers).

Fluids, propranolol and hydrocortisone, iodine and carbimazole in emergency crisis.

89
Q

When is propylthiouracil used over carbimazole?

A

Intolerant, sensitive, inappropriate.

First trimester of pregnancy (Hepatitoxicity > carbimazoles risk of congenital defects by second)

90
Q

What advice should be given with carbimazole and propylthiouracil?

A

Agranulocytosis/thrombocytopenia - tell doctor immediately with sore throat, mouth ulcers, bruising, fever, malaise
Propylthiouracil has reported severe hepatic reactions - seek medical attention with anorexia, nausea, abdominal pain, jaundice, dark urine.

91
Q

What is the difference between liothyronine and levothyroxine

A

Liothyronine is faster acting so used in severe states.

Brands may not be bioequivilant

92
Q

What relevance do cardiac disorders have on the use of Thyroid hormones ?

A

ECG is useful as changes induced by hypothyroidism can be confused with ischaemia. Doses are started lower and adjusted slower in cardiac disease. If diarrhoea, nervousness, rapid pulse, insomnia, tremor or angina pain occur (fast metabolism) the dose should be reduced or withheld for 1 - 2 days and started again at lower dose.

93
Q

Can thyroid hormones be used in pregnancy?

A

May cross the placenta but changes in hormones can be detrimental to foetus so requirements may increase during pregnancy. Assess function throughout pregnancy.

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